1578762407 NPI number — DR. AMY IRENE GREGG PH.D., M.A.

Table of content: DR. AMY IRENE GREGG PH.D., M.A. (NPI 1578762407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578762407 NPI number — DR. AMY IRENE GREGG PH.D., M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREGG
Provider First Name:
AMY
Provider Middle Name:
IRENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOERRING
Provider Other First Name:
AMY
Provider Other Middle Name:
IRENE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578762407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 BENITO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA CRUZ
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95062-2153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-655-4030
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5905 SOQUEL DR
Provider Second Line Business Practice Location Address:
STE 500
Provider Business Practice Location Address City Name:
SOQUEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95073-2855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-655-4030
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY 26881 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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